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0 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITE ADDRESS: PROPERTY TAX# PERMIT# <br /> /go 1 1-10Yr AVE 00 » 50,9 MILiOci - 050 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> OWNER lu - <br /> �7Zi`ST S L I I C Phone/E-mail �Z� 2 5`� `'q <br /> Address Y1Z-\ I t-O"{T 4 LI L City/State/Zip a;I O-r, LL) F Z 0 ) <br /> APPLICANT:_Owner _Owner's Agent X Contractor _Contractor's Agent _Tenant(must provide a letter of consent from the owner to do work in the space) <br /> CONTRACTOR S`)"j'.40 41 C(-1/Mt4 I C. 'I i:+9 State Lic.# SOLS N M S q 51�a'City Bus. Lic.#O (o S 69 <br /> Address- 0 sj:Iii E ") P-'p truM5t1 j'4 1 6i 2-9 Phone/Email ' Z) - 7l0 - -15-L1-- <br /> TENANT <br /> 5--1--TENANT BUSINESS NAM �ou 61,9 <br /> ,1 10�e.r CONTACT FOR PERMIT k-i;c L 1-31(-CM SC L V� Z€ `` C L t f 100 r 1-11)--Z10-75,ZZ J <br /> Phone/E-mail h: I G+'I�J CIisIC1ILtL(LK,i/ (z)ih <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK f C JO C"�.G' <br /> Existing Use of Building 1IEI�►C 4-c C t, I)`i( HEAT SOURCE: <br /> Proposed Use of Building 41 O)i G L L i M( C Gas Electric /( Other <br /> Building type: _Single Family _Duplex_Townhouse _Multi-Family '(Commercial <br /> Type of project: _New _Addition )( Remodel Repair_T.I._Sign_Sprinkler_Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): <br /> A-D -Z NEk) e, )��Zbq(N/-t L1Cy U i C. syS;Z <br /> j C !;-1,Pr C- IZ'T P1:h'u &;( . <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn ,,Alteration_Repair Type of Project: _New_Addn _Alteration_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> A/C-air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping Lavatory(wash basin) <br /> Water heater Shower <br /> Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer <br /> Range hood Water heater <br /> Exhaust fan Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer <br /> Unit heater Urinal <br /> Boiler Drinking Fountain <br /> Refrigeration Floor drain <br /> Woodstove Grease trap <br /> Ducting Roof drains <br /> Other Medical Gas <br /> SPRINKLER/ SUPPRESSION SYSTEM Other: <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be comp) <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> q/Z3 7C-1 4-1 <br /> Owner/Authorized Agent Signature Date (Revised 9/2014) <br />